Researchers in Canada have found that use of selective serotonin reuptake inhibitors (SSRI) is linked to an increased risk of intracerebral and intracranial haemorrhage, but that the risk is low.

In the multi-study analysis, published in the 17 October online issue of Neurology, Daniel G Hackam and Marko Mrkobrada from Western University in London, Ontario, Canada, analysed all of the studies that have looked at antidepressant use and stroke, which included 16 studies with more than 500,000 total participants. They found that people taking SSRIs, which are the most commonly used antidepressants, were 50% more likely to have an intracranial haemorrhage than those not taking the antidepressants and about 40% more likely to have an intracerebral haemorrhage.

Hackam advised that the findings should be viewed with caution. “Because these types of strokes are very rare, the actual increased risk for the average person is very low,” he said.

An estimated 24.6 of these strokes occur per 100,000 people per year. According to the research, the use of SSRIs would increase the risk by one additional stroke per 10,000 people per year.

“Overall, these results should not deter anyone from taking an SSRI when it is needed,” Hackam said. “In general these drugs are safe, and obviously there are risks to having depression go untreated. But doctors might consider other types of antidepressants for people who already have risk factors for these types of strokes, such as those taking blood thinners, people who have had similar strokes already or those with severe alcohol abuse.”